Abstract Pressure ulcers are a significant healthcare problem for the growing number of older long-term care (LTC) residents in the United States and around the world. Pressure ulcers diminish quality of life, exact a devastating loss of function, increase the risk of death in geriatric populations and raise healthcare costs. Costs for the management of pressure ulcers in the US likely exceeds $6.4 billion annually, with a prevalence of approximately 12% in the high risk LTC population. At Pitt, we have been studying the effects of seat cushions on pressure ulcer incidence and have found that when a skin protection seat cushion is used with a properly fitted wheelchair there is a significant reduction in incidence. Our data has now led us to question whether having a properly fitted wheelchair also has a significant effect on pressure ulcer incidence. To investigate this question, we are proposing a new study, RCT Wheelchair 2 (RCT-WC2), in which subjects will be randomized into a control group that receives a skin protection cushion and wheelchair training for use in their facility supplied wheelchair, or a treatment group that receives a skin protection cushion, wheelchair training and a new custom-fitted wheelchair. We expect that the treatment group will have a lower incidence of pressure ulcers.